Survival benefit of guideline-directed medical therapy in older patients with heart failure: a systematic review and meta-analysis.
Elinor Tan, Chan Meei-Wah, Yao Hao Teo et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the survival benefits of guideline-directed medical therapy (GDMT) in older patients (≥65 years) with heart failure and reduced ejection fraction (HFrEF). The analysis included 34 studies with 92,916 patients, revealing that GDMT was associated with a survival benefit (HR 0.69) in this population, although frail patients were less likely to receive GDMT.
Key findings
- GDMT was associated with a survival benefit in older patients with LV systolic dysfunction (HR 0.69, p<0.001).
- Frail older patients were less likely to receive GDMT (RR 0.63, p=0.009).
- Older patients receiving beta-blockers had a higher risk of developing bradycardia (RR 3.98, p<0.001).
- No significant differences in hypotension, acute renal impairment, or hypoglycaemia were found between GDMT and control groups.
Why it matters
Understanding the survival benefits of GDMT in older patients with HFrEF is crucial for improving treatment strategies. This population often faces challenges in receiving appropriate therapies, particularly those who are frail, highlighting the need for tailored approaches in clinical practice.